Staff at specialist orthopaedics trust felt 'failure was not an option'

A “pressurised” culture at Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust led to a situation where staff at every level felt “there was no option of failure”, an independent review has concluded.

Consultancy Deloitte was commissioned by the trust to review governance procedures relating to referral to treatment waiting times, following claims made by a whistleblower.

“The executive team as a whole has failed to tackle issues collectively in a comprehensive way”

Independent review

The trust is under investigation by the regulator Monitor for patients waiting too long and the accuracy of its referral to treatment waiting times. Wendy Farrington Chadd resigned as chief executive in September, following the announcement of a Monitor investigation.

The separate review by Deloitte, sparked by claims of “systematic and deliberate” fraud regarding performance data, found that hundreds of patients had been excluded from the trust’s waiting list on a monthly basis over a 14 month period.

In its second and final report on the review, Deloitte stated it was reasonable to conclude that there was a ”pressurised culture where staff, at all levels, felt that there was ‘no option of failure’.”

It said there was an “inhibited” culture, particularly among executives and there was evidence of its “proliferation” throughout the trust’s senior management.

Executives in charge of the referral to treatment process did not have “sufficient knowledge” of how it worked and for several months there was no expert in post, which put the trust “at risk”.

When concerns were raised by junior staff there was no “decisive decision making” taken by the board.

The investigators noted that the trust is operating in a “complex” environment, where it had to manage different national access standards between Welsh and English patients.

It had struggled to attract leadership staff and senior management turnover in some posts has been high, said the Deloitte report, which was published within latest trust board papers for November.

The report concluded there were multiple factors to explain why the trust submitted incorrect data on its waiting times performance.

The small group of staff responsible for checking the data were working within a “target driven culture” in which several staff stated that “failure was not an option”.

The investigators were “led to believe” that patients excluded from the list had been externally checked, but they added: “We have not seen any evidence of any external validation.”

The report said: “In an environment of increasing pressure, where there was limited support, these rules were applied in increasing numbers to validate and exclude patients.”

“Some of the findings make uncomfortable reading and we do not shy away from that”

Frank Collins

The report said: “Some executives do receive positive feedback from peers and staff; however, the executive team as a whole has failed to tackle issues collectively in a comprehensive way.”

When staff did raise concerns, the board “did not exercise sufficient leadership in their response”. A staff survey by the consultancy “highlighted the extent of blame culture at the trust, and the disconnect between senior managers and teams”.

Trust chair Frank Collins said: “Any review into organisational behaviour and culture has the potential to appear, on the face of it, highly critical. Deloitte have, at our invitation, been looking at the organisation through a microscope. A report of this nature does not necessarily touch on the myriad of truly exceptional activities going on across the trust.

“Some of the findings make uncomfortable reading and we do not shy away from that, but the overarching feedback I have received in many conversations is that this is a trust in a really good place that is delivering excellent patient experience and outcomes for people from England, Wales and further afield,” he said.

“However, we must tackle the issues that Deloitte have identified and we accept all 12 of the recommendations contained within the report. We have already put in place plans of action against all of those recommendations and we will be revisiting those regularly to ensure, as a board, that we are assured and reassured on the progress we are making,” he added.

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